Renal biopsy in children with asymptomatic hematuria or proteinuria: survey of pediatric nephrologists

Abstract

The decision to perform a renal biopsy on children with asymptomatic hematuria or proteinuria remains a problem for clinicians. To assess the current opinion of 349 pediatric nephrologists on this issue, case summaries of a 9-year-old boy with 20 urinary red blood cells per high power field without proteinuria and a 9-year-old boy with 2+ proteinuria (600 mg/day) without hematuria were distributed to each specialist. Seventy-three percent (n=256; 3∶1, male:female) responded. Five percent would biopsy the child with asymptomatic hematuria. The main reasons were academic interest, parental pressure for a diagnosis/prognosis and concern for future economic impact on the child (i.e., life insurance). The determinations to biopsy for hematuria were not related to age or sex of the nephrologist. In contrast, 38% (n=96) of the pediatric nephrologists would perform a biopsy on the child with proteinuria. The major reasons for biopsy were academic interest and potential for drug therapy. With a normal history, physical examination and laboratory/radiographic evaluation, the vast majority of pediatric nephrologists in North America support a conservative approach to the child with asymptomatic hematuria or proteinuria.